Walking for back pain: what the WalkBack trial found

Is walking good for back pain? It has one of the larger trials behind it. In WalkBack, adults who had recently recovered from back pain and followed a coached walking plan went nearly twice as long before the next bout that limited them. The trial tested walking plus coaching, so it can't say how much the walk alone did. For a start of your own: check the warning signs, begin from the walking you already do at a pace where you can talk, and build up slowly.

Back pain often comes back. Most guidance says to stay active, and for years researchers had no trial of the most ordinary activity there is. When Pocovi's team searched for trials of walking, cycling or swimming to stop back pain coming back, they found none, so they ran one. The result, published in The Lancet in 2024 with Pocovi as first author and Mark Hancock as senior author, is the WalkBack trial.

It's worth reading closely, because the details are what you can use. Below: what the trial tested, what it can't tell you, and a way to start your own walk that borrows its best ideas.

What did WalkBack test?

1. Who was in it

Between 2019 and 2022, the team screened 3,206 people across Australia and enrolled 701 adults who had recovered from a bout of non-specific low back pain within the previous six months. Most were women (81%), and the average age was 54. Half were assigned to the walking program and half to no extra help, and both groups were followed for one to three years.

One detail matters for anyone reading this. People who already walked for exercise at least three times a week for 30 minutes or more, or who were already active for more than 150 minutes a week, were left out. The authors say their results "do not generalise to active adults." WalkBack is a trial of people who weren't walking much, starting.

2. What the walkers did

Each walker had six sessions with a physiotherapist trained as a health coach: five in the first 12 weeks and a booster at six months. The first visit looked at how much the person already walked and set a starting dose, adjusted to their age, health, time, surroundings and goals. The guiding target was five walks a week of at least 30 minutes by six months, and that too was adjusted to the person. Walkers got a step counter and a walking diary for the first 12 weeks, plus education about back pain.

Here's what that looked like in practice. In the first week, walkers logged a median of 80 minutes over three walks. By week 12 it was 130 minutes over four walks. That is a gradual build, starting from where people were.

3. What happened

The walking group went a median of 208 days before their next bout of back pain that limited what they could do. The no-help group went 112 days. In the authors' terms, the risk of a recurrence was 28% lower (hazard ratio 0.72). The walkers also reported slightly less back-related disability over 12 months, and the program was likely to be cost-effective.

Two less quoted findings are just as useful. First, walkers reported more problems in the legs and feet: 21% of walkers against 12% of the no-help group over 12 months, about twice as many such events. Second, by 12 months the walking group no longer walked more than the comparison group. The authors suggest some reasons: support ended, the diary stopped after 12 weeks, the comparison group walked more over time, and leg problems.

What WalkBack can't tell you

4. Walking and coaching came as one package

The authors are clear that the "relative importance of the walking programme, and the education" is unknown. A coach helped each person set goals and keep going, and taught them about back pain. So the honest reading is that walking with coaching and a diary went with longer gaps between bouts. It doesn't show that walking alone stops back pain coming back, and nothing tested here prevents every flare.

The trial was also not blinded: walkers knew they were walking, and recurrences were self-reported each month. And it was a trial of people who had just recovered, not of people in the middle of a flare.

5. Walking versus other exercise

If you're wondering whether a specific routine would do better, the wider evidence suggests the type matters less than doing it. A Cochrane review of 249 trials in adults with long-lasting back pain found that exercise helped a little: pain was about 15 points lower on a 0 to 100 scale than with no treatment, usual care or placebo, with smaller gains in daily function (Hayden et al., 2021). Another Cochrane review, of 29 trials, found that training the deep "core" muscles specifically did no better than other exercise (Saragiotto et al., 2016). And a review of five trials comparing walking with other exercise for long-lasting back pain found similar improvements in pain, function and fear of movement (Vanti et al., 2019). The best movement is the one you'll keep doing.

Greg Lehman, a physiotherapist and chiropractor who teaches courses on pain science, puts the everyday version plainly. Summing up laboratory and animal studies of spinal discs (not trials in people with back pain), Lehman says: "dynamic loading means you get up you move you walk you sleep you change something." Then the caveat: "don't be an idiot and do too much too soon" (video, 2020, 8:50 and 9:04).

How to start your own walk

6. Check the warning signs first

Serious causes of back pain are rare, but a few signs mean you should get checked before you build up any walking. In the words of the 1h Protocol to Manage Back Pain:

If you're pregnant, talk to your midwife or doctor about your back. If you've had back surgery recently, follow the advice of the team that treated you.

7. Start from the walking you already do

WalkBack began with how much each person already walked. Do the same: count all the walking you do on most days, even split across the day, not counting getting around. The program turns that into a first dose. If you don't walk most days, it starts at 10 minutes; if you already walk 10 to 20 minutes, it starts at 15; 20 to 30, at 25. If moving tends to make your back worse, it starts at five. Those are the program's starting points, not tested numbers. Two walks of five minutes count.

Tie the walk to something that already happens: after a meal, on the way to the shops, with the dog. Put your shoes by the door. In the trial, the coaching was built around making the walk fit each person's day, and that part you can copy for free.

8. Walk at a pace where you can talk

You don't need to walk fast. UK public health advice describes a brisk walk as one where "you can still talk but cannot sing the words to a song" (NHS). That is general health advice, not a back pain rule, and the NHS minute targets for adults are about overall health, not backs (NHS guidelines). For your back, the useful test is the next day.

9. Use a 0 to 10 guide, and build up slowly

Some pain while you walk can happen. The program rates it from 0 to 10, where 10 is the worst you've ever had, and suggests staying at 5 or under; above 5, go slower, do less, or rest a little longer. Those bands come from NHS inform's back pain page, where 4 to 5 is "acceptable pain" and your pain should be "no worse the morning after" (NHS inform). Applying them to walking is the program's adaptation, not a tested rule.

To build up, the program adds five minutes once a week of walks has gone mostly no worse. That step is the program's own; the NHS says simply to "increase your walking distance gradually," and Australia's care standard says, if pain is worse after activity, to "take things a little easier at first and gradually build up over a few days or weeks" (ACSQHC). Bad weather or a bad day? Walk indoors, or do half.

10. Write it down

WalkBack walkers kept a diary for 12 weeks, and walking fell off after support and the diary stopped. A diary on its own isn't proven to keep you walking, but a simple record shows you what happened: minutes walked, and how your back felt the next morning. If a flare comes, keep a short walk in your smaller day; see rest or move with back pain.

Back to the trial

WalkBack's walkers started with a median of 80 minutes a week and built slowly, with someone helping them fit it into their lives. Their gap to the next bout of back pain nearly doubled. The trial can't separate the walk from the help, and it can't promise anyone a back that never flares. It does give a plain, low-cost starting point. As Lehman puts it: "you get up you move you walk." Start with the walk you already have.

For the wider picture, see lower back pain. If your bad days follow a big effort, back pain after a busy day covers the other side of building up.

To build this around your own back days, try the 1h Protocol to Manage Back Pain, a program of practical education. Its free first chapter starts with a quick check for warning signs, asks a few short questions about your last bad back day and finds your pattern: one of four, or the Tune-up. If no single trigger stands out, your pattern may be the Tune-up, and your first step is a short walk at a pace where you can talk. The full program takes about an hour. Its seven chapters show why it keeps coming back, walk one back day with you, then plan a flare, the days after it and the days that don't go to plan. You leave with two or three things to start now, each with an alternative for harder days, your flare plan with one line in your own words, and a flare card for your lock screen. Then you get fourteen days to try it, with a sheet, reviews on days 7, 14 and 30, and four one-tap check-ins by email if you're signed in. Start free

Frequently asked questions

Is walking good for lower back pain?

It has a large trial behind it. In the WalkBack trial, 701 Australian adults who had recently recovered from back pain and followed a coached walking plan went a median of 208 days before their next limiting bout, against 112 days without it (Pocovi et al., 2024). The plan included coaching, so walking alone wasn't tested.

How long should I walk with back pain?

Start from what you already do. The program starts at 10 minutes if you don't walk most days (5 if moving tends to make your back worse) and adds five minutes once a week has gone mostly no worse. Those are starting points, not tested numbers. WalkBack's walkers began at a median of 80 minutes a week.

Is walking better than exercises for back pain?

Not clearly better or worse. A review of five trials found walking and other exercise gave similar improvements for long-lasting back pain (Vanti et al., 2019), and training the core specifically did no better than other exercise (Saragiotto et al., 2016). Choose the movement you'll keep doing.

What if walking makes my back hurt?

Go slower, do less or take a short rest, and aim to stay at 5 or under out of 10, with your back no worse the next day. If walking brings on weakness or numbness in one leg, see a doctor first. If both legs feel weak, numb or tingly, or you can't walk because of the pain, get medical help straight away.

Do I need to walk fast?

No. A pace where you can talk but not sing is the NHS's description of a brisk walk for general health (NHS). For your back, how you feel the next day is the better guide.

Sources

This article draws on the WalkBack trial by Natasha Pocovi, Mark Hancock and colleagues, Greg Lehman's lecture on spine flexion, and the reviews and public guidance listed below.

• Pocovi et al, Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack) (randomized controlled trial, 701 Australian adults recently recovered from low back pain, The Lancet, 2024)
• Greg Lehman, Do you need to worry about spine flexion and low back pain? (YouTube lecture, 2020)
• Hayden et al, Exercise therapy for chronic low back pain (Cochrane systematic review, 249 trials, 2021)
• Saragiotto et al, Motor control exercise for chronic non-specific low-back pain (Cochrane systematic review, 29 trials, 2016)
• Vanti et al, The effectiveness of walking versus exercise on pain and function in chronic low back pain (systematic review and meta-analysis, 5 trials, abstract only, 2019)
• Australian Commission on Safety and Quality in Health Care, Low Back Pain Clinical Care Standard, information for consumers (national care standard, 2022)
• NHS, Walking for health (health information page, 2022)
• NHS, Physical activity guidelines for adults aged 19 to 64 (public guideline page, 2024)
• NHS inform, Exercises for back pain (health information page, 2026)